By Jennifer L. Walker
AAPA talked with Susan Manzi, MD, MPH, chair of the department of medicine and co-director of the Lupus Center of Excellence at the Allegheny Health Network (AHN), a network of eight hospitals that serve 29 counties in Pennsylvania, as well as some areas of New York, Ohio and West Virginia. Here, Manzi, who clearly loves PAs, talks about AHN’s biggest challenge with PAs (spoiler: they need more of them!), the creative ways they are utilizing PAs and the future of the profession. This Q&A was originally published in February 2017.
What has been your experience working with/hiring PAs, and where do you think you’ve succeeded organizationally with PAs on staff?
Susan Manzi: We have had a growing number of PAs join AHN. We appreciate the tremendous value they bring to our organization. PAs have played a huge role in providing access to care for an increasing number of patients trying to access AHN. I am a rheumatologist, and [Brogan Keane, the PA I work with] is incredible. My patients love her.
What are the obstacles/challenges you see with employing PAs?
Manzi: Our biggest challenge is finding enough qualified PAs to join the Network. Right now, the majority of our PAs are working in the subspecialty areas, while there are significantly less in primary care. We would like to change that.
What kinds of issues do you deal with surrounding PAs and scope of practice/regulatory compliance?
Manzi: We need to keep our physicians and PAs educated about appropriate documentation and insurance-specific regulatory compliance that impacts reimbursement. We conduct regular audits and overall we have done very well, but it’s about continual education for the providers.
Are you able to articulate the value of PAs from a monetization standpoint?
Manzi: PAs are invaluable. When I’m working side by side with my PA, we’re able to accommodate more patients. She has improved my patients’ satisfaction and she has enabled me to keep up with the growing number of tasks and activities required to care for patients. Her command of rheumatology has grown exponentially over the past year and the investment in her training has been well worth it. She is more knowledgeable than many young physicians out of training. I think I can speak for the other physicians in this organization when I say that we are fortunate to have PAs.
Are you adding PAs to your workforce? If so, which specialties, service lines and settings are you using them in?
Manzi: We are adding them to all of our service lines. One of our strategies has been to partner with the PA schools in the area to provide clinical experience for their students with the hope of hiring them after graduation.
Are you looking at new ways to maximize PA utilization?
ManzI: Yes, I think we’re always trying to be creative with maximizing utilization. We currently have PAs doing inpatient hospital rounding, intensive care unit coverage and outpatient practice. The PAs doing hospital coverage allow the physicians to remain in the outpatient office and provide longer hours of service. One size does not fit all and each specialty utilizes PAs differently.
Have you currently assessed whether your PA workforce is operating to maximal efficiency, education and experience?
Manzi: I can’t say that as an organization we have systematically done that. The areas that have PAs have done their own internal evaluations. Sharing best practices with each other and with other organizations is something we should be doing.
How comfortable is your team with PAs and regulatory compliance/scope of practice? Would it be helpful to have additional support services to stay up to date?
Manzi: You can never overeducate. Having said that, our organization has done a good job at providing the needed information to our providers.
How comfortable is your team with PA reimbursement and PA billing practices?
Manzi: We are always reviewing and auditing our practices, so we are generally comfortable, although the Medicare policies are complicated and vague in some instances. What I am not comfortable with is the concept that PAs should be reimbursed any differently than doctors for the same level of work. I hope this Medicare policy is revisited as more and more PAs join the provider teams.
The types of process changes that have the best opportunity to drive value include: being accountable to the patient and the creation of advanced care teams. What role do you see PAs playing as you implement/advance these process changes?
Manzi: Everything is moving toward team-based … and [PAs] are a part of the team. The PA plays a critical role in our team-based models.
Are there things other hospital administrators and physicians don’t “get” about PAs that become a source of frustration?
Manzi: There is a perception that patients may not want to see a PA. They want to see the doctor. It is our responsibility to alleviate those fears by educating our patients about the value provided by PAs. My approach is to say, “Meet [Brogan], she is my partner, we are a team, she’s incredibly knowledgeable, we work well together and she’s going to be participating in your care.” Advanced care teams are moving toward sharing in the care of patients and away from physician-centric approaches.
At your organization, is there a career ladder or trajectory for PAs?
Manzi: We are developing a ‘lead physician extender’ [AHN’s term for PAs and NPs] role, somebody [who] assumes a leadership position over all of the PAs and NPs in a practice or subspecialty. This individual develops best practices, does onboarding and training of new providers and oversees practice efficiencies and processes. There are other potential roles in education, research and training available to our PAs.
Have you found success in recruiting and retaining PAs? Or, is it a challenge for your organization? How do you define success and to what do you attribute your success?
Manzi: Recruiting and retaining healthcare providers is always challenging, especially PAs. To recruit and retain our best PAs, we need to provide a competitive salary structure with a nurturing work environment. PAs are highly sought after and it is a competitive market place. We are committed to growing our PA network.
What do you think the future holds for PA utilization in your organization?
Manzi: I think [their stature] is going to continue to rise. As an organization, we have not taken full advantage of PAs, except in certain areas, including procedural and surgical subspecialties. We are growing the PA pool in other medical subspecialties and we are committed to building the PA infrastructure in primary care. I see a future where all patients are cared for by healthcare teams, including physicians, PAs and NPs, pharmacists, nutritionists, and health coaches with reimbursement models that can support and sustain this approach. PAs will be key members of these care teams.
Are PAs a part of your strategy to successfully transition from fee-for-service to value-based reimbursement contracting?
Manzi: Yes, we are moving in that direction. The whole organization is. We are working on new compensation models for our providers in general, and I’m very excited about that. I think we have a great opportunity as an integrated delivery system to do that since our owner really wants us to deliver quality not quantity.
Jennifer L. Walker is a Baltimore-based freelance writer. Contact her at [email protected].